Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study -- Gill et al. 330 (7489): 445 -- BMJ
BMJ article asks if certain antipsychotic drugs prescribed to contol psychotic* symptoms in older patients with dementia increase the odds of having a stroke. I find the mention of "non-pharmacological harm reduction strategies" especially interesting. Non have been offered for dad by either medical professionals nor the extra care accommodation which lacks funding for activities."In this population based cohort, older adults with behavioural and psychological symptoms of dementia (BPSD) who received atypical antipsychotic drugs seem to have a similar risk of admission to hospital for ischaemic stroke as those receiving typical antipsychotic drugs. These findings are important because of the frequency with which atypical antipsychotics are used to manage BPSD.6 Our results may help to inform drug prescribing for this group of patients.
What is already known on this topic
Atypical antipsychotics are commonly used to manage behavioural and psychological symptoms of dementia (BPSD)
Recent evidence from clinical trials suggests an association between atypical antipsychotic use and cerebrovascular events (including stroke) among older adults with BPSD
These data prompted the UK Committee on Safety of Medicines to recommend against the prescribing of atypical antipsychotics to patients with BPSD
What this study adds
Use of atypical antipsychotics by patients with dementia is not associated with a greater risk of stroke is than use of typical antipsychotics
Findings were consistent for a series of subgroup analyses including ones for patients at high baseline risk of stroke
The choice of atypical or typical antipsychotics to manage BPSD should not be based on concerns about the risk of stroke"
What do these results mean for clinical practice?
Clinicians managing patients with dementia who develop behavioural disturbances should initially rule out underlying medical illnesses or drugs that might predispose to delirium.33 If BPSD is diagnosed, clinicians should initially consider non-pharmacological harm reduction strategies such as education of family members, ABC charting, and music therapy.3 If pharmacotherapy is considered necessary, it should be tailored to the individual. Our data show that the risk of ischaemic stroke is similar for patients receiving atypical antipsychotics and those receiving typical antipsychotics. Other potential risks of antipsychotics (for example, extrapyramidal symptoms, tardive dyskinesia) should also be weighed against the benefits. A working group of psychiatrists, general practitioners, and geriatricians in the United Kingdom has developed guidelines for the management of BPSD in people with a history of stroke or transient ischaemic attack.34 Unfortunately, many of the alternatives to atypical antipsychotics for managing BPSD have received only limited evaluation and have their own important adverse event profiles.4 The US National Institute of Mental Health is currently sponsoring the clinical antipsychotic trials of intervention effectiveness (CATIE) Alzheimer's disease trial, which is a 36 week study comparing three atypical antipsychotics, a selective serotonin reuptake inhibitor, and placebo to treat BPSD. Results are due in 2006.35 This study and others36 should shed light on the optimal management of BPSD and the risk of stroke in this patient population.
* Dementia.com Glossary
"Psychosis
A mental disorder causing the individual to lose contact with reality. Characterized by impairment in reality testing, which manifests as delusions, hallucinations, incoherent speech, and disorganized and agitated behavior."
posted by Jen @ 12:34 AM
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